镍钛合金机用根管器械折断的研究进展

镍钛合金根管器械的折断往往以无任何明显征兆为特征,因此其预防较为困难。本文就镍钛合金机用根管器械折断的分类、影响折断的因素及预防措施作一简要综述。     

机用镍钛器械预备清理根管效果的定量分析

目的:比较机用镍钛根管预备器械ProFile与手动器械对弯曲根管的清理效果.方法:3组弯曲根管分别进行ProFile、手动不锈钢RT锉、NiTiflex锉预备.立体显微镜下观察根管纵截面并采用图象分析软件Scion Image 1.62定量分析根管碎屑分布比例与根尖栓塞的形成.结果:ProFile组碎屑指数小于其他两组;碎屑栓发生率各组无显著性差异,但与根管弯曲部位相关.结论:ProFile器械采用冠根向深入法对弯曲根管碎屑的清理优于手动器械,但仍应注意弯曲位于根尖1/3段者易发生根尖阻塞.     

ProFile镍钛合金根管预备器械研究进展

ＰｒｏＦｉｌｅ镍钛合金根管预备器械有三种不同类别,均为大锥度器械,采用冠根向预备技术,以１５０～３５０ｒ／ｍｉｎ的转速进行根管预备。该器械柔韧性佳,切削能力强,尤其在预备变曲根管时安全、快捷,根管成形理想。     

ProTaper机用镍钛锉根管预备的临床效果分析

目的 评价ProTaper机用镍钛锉根管预备的临床效果。方法 选择300颗患牙（638个根管）随机分为ProTaper组和K锉组,分别用ProTaper机用镍钛锉和K锉进行根管预备,采用χ2检验比较根管预备后的疼痛反应、根管充填效果及器械分离情况。结果 ProTaper组根管预备后疼痛发生率为6.00%,较K锉组的根管预备后疼痛发生率（26.67%）少（P<0.01）,ProTaper组根管恰填率为93.77%,较K锉组（88.64%）高（P<0.05）,两组间的器械分离则无统计学差异（P＞0.05）。结论 ProTaper机用镍钛锉能有效降低根管预备后疼痛的发生和提高根管充填质量,而且较为安全。     

ProFile镍钛合金根管预备器械研究进展

ProFile镍钛合金根管预备器械有三种不同类别,均为大锥度器械,采用冠根向预备技术,以150～350r/min的转速进行根管预备。该器械柔韧性佳,切削能力强,尤其在预备弯曲根管时安全、快捷,根管成形理想。     

机用镍钛旋转器械在根管预备中的临床观察

机用镍钛旋转器械为根管治疗开创了新的局面。2 0 0 0 - 0 9我科将该设备应用在根管治疗中 ,现报道如下。1　材料和方法1.1　材料机用镍钛合金旋转调速驱动器、配备 36 0度旋转减速比的弯手机。普发 (Profile )镍钛根管锉针 ,分为三种不同类别 :根管口成形锉 (Orificeshapers ,OS) ;锥度 5 %～ 8%,共分# 1～ # 6 ;0 .0 6Profile锥度 6 %,共分 # 15～ # 40 ;0 .0 4Profile锥度 4%,共分 # 15～ # 90 ;均为美国登士柏公司生产。1.2　临床病例选择门诊 16～ 6 0岁牙髓炎、根尖周炎患者 2 2 0例2 5 3牙。均为根管细小或有一定弯曲度及难度较大…     

两种机用镍钛器械预备老年人磨牙弯曲根管临床效果评价

目的    评价两种机用镍钛器械M3-Pro和Twisted File（TF）在老年人磨牙弯曲根管预备中的临床应用效果。方法    选择2015年6月至2017年9月在青岛市口腔医院牙体牙髓科门诊就诊的60 ~ 70岁因牙髓病需要行根管治疗的初诊患者215例,按Schneider测量法选择弯曲根管（25° ~ 30°）磨牙240颗,随机均分为M3-Pro组和TF组,分别用M3-Pro和TF机用镍钛器械进行根管预备,比较两组在根管预备时间、根管预备后疼痛反应、根管充填效果、器械分离和损伤情况等方面的差异。结果    M3-Pro组的根管预备时间为（5.22 ± 1.12）min,TF组为（6.47 ± 0.93）min,组间差异有统计学意义（t = -17.816,P < 0.05）;M3-Pro组根管治疗期间急症发生率为3.3%,TF组为2.5%,组间差异无统计学意义（χ2 = 0.147,P > 0.05）;M3-Pro组根管恰填率为96.72%,TF组为95.84%,组间差异无统计学意义（χ2 = 0.463,P > 0.05）;两组各使用镍钛器械120支,均未发生器械分离,M3-Pro组发生10支器械损伤,TF组发生21支器械损伤,组间差异有统计学意义（χ2 = 4.482,P < 0.05）。结论    M3-Pro能够高效率地进行根管预备,可有效降低根管治疗期间急症的发生,也能更好地保持根管解剖的原始走行,明显减少器械分离的发生,尤其适合弯曲根管的治疗,临床疗效较好。     

机用镍钛器械根管预备效果的研究进展

根管治疗是目前治疗牙髓病和根尖周病的主要方法,而根管预备则是根管治疗的关键步骤,良好的根管预备能有效清理根管内感染物并且能为根管充填提供良好条件。镍钛器械的研发使根管预备有了新的突破,因其记忆弹性大、抗弯曲性强、切削力大、切削效率高的特点逐步取代不锈钢器械。随着镍钛根管锉的不断革新,机用镍钛器械在临床上已经广泛使用。因此,研究机用镍钛器械不仅能够指导根管预备,而且对其创新有较大意义。本文将对机用镍钛器械的成形能力、抗疲劳性能、根管治疗后并发症等作一综述。     

镍钛机用器械根管预备

自1988年Johnsen发明Profile后,镍钛机用器械逐渐成为根管预备的主要器械,医师可以借助机动器械对根管进行安全处理,引发了根管治疗的技术革命。1.镍钛机用器械概述目前国内使用的系统主要有:Profile(Dentsply)、ProTaper(Dentsply)、Hero642(Micro-Mega)、Hero Shaper(Micro-Mega)、K3(Sybronendo)、Flexmaster(VDW)、Race(FKG)、GT(Dentsply)和Light Speed(LigthSpeedUSA)等,这些系统有一定的相似性,也有各自的特点。镍钛机用系统的共同特点:①镍钛金属材料的成分基本雷同;②大锥度的设计;③均为螺旋设计,器械在根管中能方…     

ProTaper机用镍钛锉预备根管的临床评价

目的观察ProTaper机用镍钛锉的根管预备效果。方法将行根管治疗的76颗患牙共146个根管随机分为P组（38颗牙，74个根管）和S组（38颗牙，72个根管），P组用ProTaper机用镍钛锉冠根向逐步深入法预备根管，S组用手用不锈钢锉逐步后退法预备根管，观察两组在根管预备时间、锉折断、备根后患牙的疼痛发生率和根充效果的差异。结果P组根管预备时间平均为4min20s，明显少于S组的9min31s；两组的器械折断率无显著性差异（P〉0．05）；P组备根后疼痛发生率为5．3％，明显低于S组的23．7％（P〈0．05）；P组根充恰填率明显高于S组（P〈0．01），欠填率明显低于S组（P〈0．01）。结论只要掌握冠根向备根技术的要点，ProTeper机用锉比传统手用不锈钢锉更省时省力，可以有效地降低术后疼痛发生率，提高根充效果。     

4种机用镍钛器械预备模拟弯曲根管的效果评价

目的:比较4种机用镍钛器械预备模拟弯曲根管的成形效果。方法:40个单弯(弯曲度38.5°)树脂根管,随机编号分4组(Hero642、Protaper、K3及Mtwo)。按厂家推荐方法预备,记录预备时间,扫描仪获取图像,使用图像分析、测量软件将预备前、后的图像重叠,测量根管内、外侧壁树脂去除量、弯曲度及弯曲半径等的变化。采用SPSS13.0软件包对数据进行单因素方差分析。结果:K3预备速度最慢,Mtwo最快(P<0.05)。在根管弯曲起始点(BC)、根管口(O)和两者中点(HO)处内侧壁以及弯曲最凸点(AC)、HO和O处外侧壁的预备量4组间差异显著,Protaper预备后根管锥度变化最大,Hero642最小(P<0.05)。Protaper在根管弯曲段的中心定位能力最差;越接近根管下份偏移增大。K3与Protaper各1例断针,K3有2例台阶,安全性能、不良形态、根管弯曲角度及半径的改变方面,4种器械无显著差异,但预备后根管工作长度缩短,略有被拉直趋势。结论:Mtwo能快速预备根管;Protaper预备后根管锥度最明显;4种机用镍钛器械均具备良好的切屑力且维持原始根管走向。     

两种K型锉预备弯曲人工根管效果的比较

目的 :比较镍钛K型锉和不锈钢K型锉常规法预备弯曲人工根管的切削能力和成形能力。方法 :分别用两种K型锉预备弯曲人工根管 ,电子分析天平称量标本的失重量 ,光学显微镜下观察根管形态变化。结果 :不锈钢K型锉切削能力较强 (P <0 .0 1) ,所有标本未发现根尖拉开、肘部形成和穿孔 ,预备后根尖孔直径镍钛K锉组明显小于不锈钢K锉组 (P <0 .0 0 1)。结论 :镍钛K型锉能保持弯曲根管良好的根管形态 ,而且试尖效果好 ,推荐临床使用     

三维自调节根管预备锉

镍钛旋转器械预备后的根管横切面为圆形,普遍存在近远中壁过度预备,颊舌侧壁和靠近峡区的泪滴状区域及峡区未被清理等问题,而三维自调节锉（SAF）则可解决上述问题。SAF由中空可压缩的薄镍钛网丝制作而成,不仅在纵向上能顺应根管弯曲方向,在横断面上亦能适应根管形态,自动调整为圆形、扁形或椭圆形等对根管壁牙本质进行均匀的往复式切削。SAF连接冲洗系统VATEA后以持续低压传递冲洗液至根管深处,收到机械预备和化学预备同期进行的效果,有利于去除涂层,遗留的未预备面积较旋转器械少,但其去除根管内感染物质的能力尚存争议：SAF较旋转器械更容易清除椭圆形根管中的细菌,但却不能有效地预备根尖段,冲洗液也难以传递至根尖区域,导致其不能有效去除根管壁碎屑、涂层,亦不能有效地清除根尖的感染细菌。SAF的通畅能力较弱,在再治疗中主要起辅助冲洗的作用,可以去除更多的牙胶残留物。SAF不易出现器械完全分离,偶尔网状镍钛丝的一端分离,另一端仍与器械主体相连,不会出现分离端遗留根管内造成根管堵塞。以SAF联合手用锉预备根管,牙本质壁则几乎无任何微裂纹。简而言之,SAF的出现对于进一步研发和改良器械,提高根管预备效率,减少并发症具有重要的意义。     

Comparison of root canal preparation using RaCe and ProTaper rotary Ni-Ti instruments

AIM: To compare various parameters of root canal preparation using RaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) nickel-titanium (Ni-Ti) instruments. METHODOLOGY: Fifty extracted mandibular molars with mesial root canal curvatures between 20 degrees and 40 degrees were embedded in a muffle system. All root canals were prepared to size 30 using RaCe or ProTaper rotary instruments in low-torque motors with torque control and constant speed of 300 r.p.m. (ProTaper with ATR Tecnika, Advanced Technology Research, Pistoia, Italy; RaCe with EndoStepper, S.E.T., Olching, Germany). In both groups irrigation was performed with 2 mL NaOCl (3%) after each instrument size. Calcinase-Slide (lege artis, Dettenhausen, Germany) was used as a chelating agent with each instrument. The following parameters were evaluated: straightening of curved root canals, postoperative root canal cross-sections, safety issues and working time. Cleanliness of the root canal walls was investigated under the SEM using 5-score indices for debris and smear layer. Statistical analysis was performed using the following tests: Wilcoxon's test for straightening and working time was used (P < 0.05); Fisher's exact test for comparison of cross-sections and root canal cleanliness (P < 0.05). RESULTS: Both Ni-Ti systems maintained curvature well; the mean degree of straightening was less than 1 degrees for both systems. Following preparation with RaCe, 49% of the root canals had a round or oval diameter and 50% an irregular diameter, ProTaper preparations resulted in a round or oval diameter in 50% of the cases. For debris, RaCe and ProTaper achieved 47 and 49% scores of 1 and 2, respectively; there was no significant difference. For smear layer, RaCe and ProTaper achieved 51 and 33% scores 1 and 2, respectively; no statistically significant differences were apparent for the coronal and middle sections of the root canals, but RaCe performed significantly better in the apical region (Fisher's exact test, P = 0.0392). Two roots lost working length with RaCe instruments, whilst ProTaper preparation resulted in two roots loosing working length and one fractured instrument. Mean working time was shorter for ProTaper (90.9 s) than for RaCe (137.6 s); the difference was significant (Wilcoxon's test, P = 0.011). CONCLUSIONS: Both systems respected original root canal curvature well and were safe to use. Cleanliness was not satisfactory for both systems.     

两种镍钛器械联合预备弯曲根管的效果评价

目的：评价联合使用K3和TF两种不同镍钛器械预备弯曲根管的效果。方法：选择离体下颌前磨牙及磨牙各40颗,依根管弯曲度分为轻度及中重度弯曲组,每组再随机分为两组,分别采用K3联合TF、单独K3进行根管预备。记录并分析各组单根管预备时间、并发症、根管直化角度、器械中心定位能力。结果：轻度弯曲组采用K3联合TF进行根管预备仅预备时间明显短于K3组（P<0．05）;中重度弯曲组采用K3联合TF进行根管预备,预备时间、术中并发症、根管直化角度、自根尖孔1～4 mm观测点的器械中心定位能力与K3组相比均有统计学差异（ P<0．05）。结论：K3联合TF预备弯曲根管,可节省操作时间,减少并发症,更好地维持根管原有形态,尤其适用于中重度弯曲根管的预备。     

Micro-computed tomography evaluation of the preparation of long oval root canals in mandibular molars with the self-adjusting file

Introduction

The aim of this study was to assess the shaping potential of a novel nickel-titanium instrument, the self-adjusting file (SAF), in long oval root canals in distal roots in mandibular molars.

Methods

Twenty mandibular molars with long oval distal root canals were selected and scanned preoperatively and postoperatively by using micro-computed tomography at an original resolution of 20 μm. Canals were shaped with the SAF, three-dimensionally reconstructed, and evaluated for volume, surface area, canal transportation, and prepared surface. Data were statistically contrasted by using paired t tests and regression analysis.

Results

Preoperatively, canal volume was 7.73 ± 2.13 mm³, and canal area was 42.83 ± 8.14 mm². Volumes and surface areas increased significantly (P < .001) by 4.84 ± 1.73 mm³ and 3.34 ± 1.73 mm², respectively, and no gross preparation errors were detected. Unprepared canal surface varied between individual canals, and mean unprepared surface was 23.5% ± 8.9%. Prepared areas were significantly larger compared with rotary canal preparation done in a previous study. Canal transportation scores were higher in the coronal root canal third (106 ± 50 μm) compared with the apical third (81 ± 49 μm).

Conclusions

In vitro, preparation of long oval-shaped root canals in mandibular molars with the SAF was effective and safe. Moreover, shapes generated with the SAF were more complete compared with rotary canal preparation.     

两种机用镍钛根管预备器械在树脂模拟弯曲根管内的成形能力

目的 利用树脂模拟弯曲根管,研究K3和Hero642两种机用镍钛根管预备器械的成形能力.方法 使用K3和hero642分别预备两组树脂模拟弯曲根管至06锥度25#,运用扫描仪采集根管预备前后图像,Image ProPlus软件测量根管预备后的根管宽度和预备前后的弯曲度,使用SPSS13.0统计软件对预备前后树脂模拟弯曲根管宽度和弯曲度变化进行统计学分析.结果 K3组和Hero642组根管预备前后角度的变化分别为（4.11±0.18）°和（4.05±0.23）°,两者差异无统计学意义（P＞0.05）;两组器械预备后根管宽度的比较在根尖1/3、根中1/3和根管口处都无显著性差异（P＞0.05）.结论 两种机用镍钛根管预备器械均能较好地完成根管预备.     

A comparative study of root canal preparation with NiTi-TEE and K3 rotary Ni-Ti instruments

Aim To evaluate and compare several parameters of curved root canal preparation using two different Ni‐Ti systems: NiTi‐TEE (Sjöding Sendoline, Kista, Sweden) and K3 (Sybron Endo, Orange County, CA, USA). Methodology Fifty extracted mandibular molars with mesial root canal curvatures ranging from 20 to 40° were divided into two groups. In one group, 50 root canals were instrumented using NiTi‐TEE files to an apical size 30; 0.04 taper (the largest available size at the time of this study). In the other group, 50 root canals were prepared with K3 instruments to an apical size 45; 02 taper. Both systems were used in a crowndown manner, with copious NaOCl (3%) irrigation and a chelating agent (Calcinase Slide, lege artis, Dettenhausen, Germany), employing torque‐controlled motors. For assessment of shaping ability, pre‐ and postinstrumentation radiographs and cross‐sectional photographs of canals were taken and changes in canal curvature and root canal diameter documented. Cleaning ability was evaluated by investigating specimens of the apical, medial and coronal third of the root canal wall under a scanning electron microscope using 5‐score indices for debris and smear layer. Procedural errors (instrument separations, perforations, apical blockages, loss of working length) and working time were recorded. Nonparametric anova was used to compare straightening of canal curvatures, canal cross‐sections and canal wall cleanliness (P < 0.05), whereas working time was analysed using the parametric anova (P < 0.05). Results Both Ni‐Ti systems maintained curvature well: the mean degree of straightening was 0.2° for NiTi‐TEE and 0.4° for K3 with no statistical significance between the groups. Post‐instrumentation cross‐sections of the root canals revealed an acceptable contour (round or oval) in 50.6% of cases for the NiTi‐TEE group and in 65.3% of cases for the K3 group. The difference was not significant. The SEM investigation of canal walls showed equally good debris removal for both systems: NiTi‐TEE prepared canal walls in 74.7% of cases with scores I and II; K3 achieved these scores in 78.7% of cases. For smear layer, NiTi‐TEE and K3 only received good scores (I and II) in 38.7% and 40% of canal wall specimens, respectively. For both parameters, no significant differences were found between groups. File fractures did not occur, but loss of working length was observed in one case following the preparation with NiTi‐TEE and in three cases during K3 instrumentation. Mean working time was significantly shorter for NiTi‐TEE (170 s) than for K3 (208 s). Conclusions Both systems maintained original canal curvature well and were safe to use. Whilst debridement of canals was considered satisfactory, both systems failed to remove smear layer sufficiently.     

机用和手用镍钛器械对不同弯曲度根管预备后的碎屑及预备效率的研究

目的 研究比较机用镍钛锉ProTaper Gold和手用镍钛锉ProTaper对不同弯曲度根管预备后的根尖碎屑推出量及预备效率.方法 将纳入标准收集的离体牙根管按不同的弯曲度(小于15°、20°～35°)分为2组,每组再按不同类型的镍钛器械(PTG、PTH)将其随机分为2个亚组(n=15).PTG组采用ProTaper...     

不同锥度机用镍钛器械预备对根管壁清洁率的影响

目的:研究不同锥度机用镍钛根管器械对根管管壁清洁率的影响。方法:选用80个单根管离体牙,随机分成4组,A组成形至30/0.04,B组成形至30/0.06,C组成形至30/0.08,而D组成形至30/0.10。纵劈各组根管,用扫描电镜观察根管壁的清洁度,并进行两两比较。结果:根冠1/3部位,4组的的差异无明显统计学意义(p>0.05);根中1/3部位,两两比较,4组的的差异有统计学意义(p<0.05);但B、C、D3组之间无明显统计学差异;根尖1/3部位,A与B相比,B与C相比,其差异均有统计学意义(p<0.05),但C和D组相比没有统计学意义(p>0.05)。结论:根管预备时增加机用镍钛器械的预备锥度,可提高根管壁清洁率。